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With COVID-19 around for ‘foreseeable future,’ public health experts urge caution as winter holidays near

Cases of COVID-19 in Maryland and elsewhere are on the rise again, and state officials and public health experts say another winter surge of infections, hospitalizations and deaths is possible if the public fails to keep the virus at bay.

For now, the emphasis remains on getting more people vaccinated, with medical professionals, researchers and public health and government officials widely agreeing that doing so can make the virus less severe over time and turn the public health crisis to more of a seasonal challenge.

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Maryland’s trends are consistent with those in much of the United States and other countries, with cases ticking back up after declines in the early months of fall, said Dr. David Dowdy, an epidemiologist and associate professor at the Johns Hopkins Bloomberg School of Public Health. He said while the three available vaccines continue to lessen the risk of serious illness and mortality in most Americans, many remain unvaccinated, and people with compromised immune systems and certain underlying medical conditions remain especially vulnerable to COVID-19.

Sherif Rezkalla, pharmacy manager at Northern Pharmacy, measures the saline diluent that will be added to the concentrated Pfizer BioNTech COVID-19 vaccine. Public health experts say more people need to be vaccinated to lessen the severity of the coronavirus pandemic, which extends into its second winter holiday season this month.
Sherif Rezkalla, pharmacy manager at Northern Pharmacy, measures the saline diluent that will be added to the concentrated Pfizer BioNTech COVID-19 vaccine. Public health experts say more people need to be vaccinated to lessen the severity of the coronavirus pandemic, which extends into its second winter holiday season this month. (Amy Davis / Baltimore Sun)

“There is never going to be a pandemic ‘Mission Accomplished’ day,” said Dowdy, who addressed reporters Wednesday during an online briefing hosted by Hopkins. “This disease is going to be with us for the foreseeable future. The question is, when can we get to the point where it’s tolerable as a society?”

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Dowdy said there are reasons to view the coronavirus pandemic with some “cautious optimism,” especially compared with this time last year, when no vaccines were yet authorized for use and even more about the novel virus remained unknown. Doctors have become better at treating severely ill patients and new antiviral drugs may soon be authorized to help patients rein in their symptoms once they contract COVID-19, he said. And most pre-pandemic staples such as in-person schooling, worshipping, shopping and operating a business at full capacity have returned.

Still, while the COVID-19 death rate also has declined significantly since last year, Dowdy said the country continues to outpace Europe in mortalities. More than 764,000 people have died due to COVID-19 since U.S. officials began tracking cases in March of last year, with close to 100,000 in the past two months alone, according to national data compiled by the Johns Hopkins Coronavirus Resource Center.

“Even if cases go up over the winter, we are unlikely to see the overcrowded [intensive care units] and makeshift morgues of a year ago,” Dowdy said. “Herd immunity as people are conceptualizing it isn’t feasible. We want to think in those terms and not ‘zero COVID.’ Zero COVID is not going to happen.”

In Maryland, cases began ticking up again in early November, with 791 cases added to the tally Wednesday, according to state data. Hospitalizations and deaths have not yet followed, though the latest figures show 525 people in hospital beds in the state, up 17 from the day before.

The testing positivity rate remains below 5%, an established threshold at which cases are considered widespread and not being fully captured by the tests.

Maryland has a relatively high vaccination rate with 78.2% of the eligible population age 12 and older fully immunized. That compares with 68.9% of the eligible population across the country.

During a Maryland Senate Vaccine Oversight Workgroup meeting in Annapolis this week, Health Secretary Dennis Schrader told lawmakers that among new cases, 66% are among unvaccinated people.

Most deaths also are among the unvaccinated, he said. An underlying condition that appears to contribute to deaths among those in their 40s or 50s is obesity.

Children are still far less likely to be hospitalized, Schrader said, with about 700 total needing such care since last year. And now that kids ages 5 to 11 are eligible for the Pfizer/BioNTech vaccine, about 11.5% have gotten their first dose, according to state data.

Rupali J. Limaye, director of behavioral and implementation science at Hopkins’ International Vaccine Access Center, said while children’s risk of contracting severe COVID-19 is low, many have died from it across the country, and even more have been hospitalized or have contracted “long COVID,” which prolongs their symptoms even after they test negative. It’s important to get kids vaccinated when they are eligible, she said.

“The vaccine can provide longer-lasting protection than natural infection,” Limaye said, adding that kids’ vaccination means more protection for older and more vulnerable family members.

Among adults who remain unvaccinated in Maryland, about two-thirds are Medicaid recipients, Schrader said Monday, and officials will try to target them for their first doses. He did not offer a geographic breakdown of that group, but about 20% of the state’s population is enrolled in the federal-state health care program for low-income residents.

All vaccinated adults in Maryland may soon be eligible for booster shots after Pfizer officials made the case to federal regulators earlier this month that third doses given after six months of receiving the second shot would provide even more protection against the virus. Regulators could authorize booster shots for all adults 18 and up as soon as this week.

About 718,000 booster shots have been given in Maryland, or about half of those the state estimates are eligible. Many states have begun approving boosters for all adults, ahead of approvals from federal officials.

Schrader has said recently the state was sticking with its current eligibility rules, which permit older adults, people with certain health conditions, people who live in congregate settings and those who work in certain “high-risk” professions to seek the shots now. People can, however, self-attest that they are eligible, and health officials said Wednesday that they are assessing whether to widen eligibility.

Many in public health say that increasing first vaccinations is more important than boosting adults, including Dowdy, who said vaccinating the unvaccinated should remain the nation’s top priority for now. That way, even more people will be kept out of hospitals and be less likely to transmit or catch COVID-19, he said.

With holiday gatherings and travel approaching, officials fearing a bigger uptick in cases say vaccinations will be crucial. Other precautions will matter, too, according to a statement from Dr. David Marcozzi, the University of Maryland Medical System’s COVID-19 incident commander and senior vice president and chief clinical officer of the University of Maryland Medical Center.

”The recipe for a safe Thanksgiving during COVID can be boiled down to four key ingredients,” he said. “Get fully vaccinated — which includes a booster vaccine; get tested before traveling or having family over; wear a well-fitting mask over your nose and mouth while engaging in activities like traveling, spending time indoors or shopping; and gather outside if possible or at least open a window for ventilation.”

He and other Maryland medical system experts suggested children should be vaccinated now so they have some protection over the holiday season. Full protection comes two weeks after the second vaccine dose. In addition to masking while traveling, they said not to forget frequent hand-washing and using hand sanitizer, which can protect people from other circulating viruses.

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Baltimore Sun reporter Pamela Wood contributed to this article.

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